在高发地区,比如中国广东省,有证据表明行细胞活检或内镜检查是恰当有助的。
巴雷特食管患者,建议长期随访以识别癌前病变(重度不典型增生)和早期原位癌。高达40%的伴随吞咽困难的巴雷特食管患者发生原位癌或者浸润癌。[59]Schnell TG, Sontag SJ, Chejfec G, et al. Long-term nonsurgical management of Barrett's esophagus with high-grade dysplasia. Gastroenterology. 2001;120:1607-1619.http://www.ncbi.nlm.nih.gov/pubmed/11375943?tool=bestpractice.com基于北爱尔兰巴雷特食管记录中心数据的一项大型队列研究调查了巴雷特食管患者进展为恶性的风险。这项研究发现恶性肿瘤的发病率低于以前其他的研究报道。[23]Bhat S, Coleman HG, Yousef F, et al. Risk of malignant progression in Barrett's esophagus patients: results from a large population-based study. J Natl Cancer Inst. 2011;103:1049-1057.http://www.ncbi.nlm.nih.gov/pubmed/21680910?tool=bestpractice.com目前对低分化的不典型增生的推荐各异,但是对于高分化的不典型增生患者一致认为不需单独进行频繁的监测和4象限活检,而应进行内镜下电灼/切除[60]Hirst NG, Gordon LG, Whiteman DC, et al. Is endoscopic surveillance for non-dysplastic Barrett's esophagus cost-effective? Review of economic evaluations. J Gastroenterol Hepatol. 2011;26:247-254.http://www.ncbi.nlm.nih.gov/pubmed/21261712?tool=bestpractice.com[61]Fernando HC, Murthy SC, Hofstetter W, et al. The Society of Thoracic Surgeons practice guideline series: guidelines for the management of Barrett's esophagus with high-grade dysplasia. Ann Thorac Surg. 2009;87:1993-2002.http://www.ncbi.nlm.nih.gov/pubmed/19463651?tool=bestpractice.com[62]Wolf WA, Pasricha S, Cotton C, et al. Incidence of esophageal adenocarcinoma and causes of mortality after radiofrequency ablation of Barrett's esophagus. Gastroenterology. 2015;149:1752-1761.e1.http://www.ncbi.nlm.nih.gov/pubmed/26327132?tool=bestpractice.com单独监测仅推荐用于非不典型增生或早期不典型增生的巴雷特食管。